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Chronic obstructive pulmonary disease (COPD) is associated with about a doubled risk of myocardial infarction (MI), or heart attack, among people living with HIV.

COPD is a collective term for various progressive lung diseases, including emphysema, chronic bronchitis and refractory (nonreversible) asthma. People with HIV are at higher risk for COPD compared with those who do not have the virus. Among HIV-negative individuals, COPD is a known risk factor for cardiovascular disease, including heart attack. Whether COPD has a similar association among HIV-positive individuals remains cloudy.

Kristina Crothers, MD, of the University of Washington, presented findings at the 2019 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle of a study in which she and her coauthors analyzed data on 22,596 HIV-positive members of the Center for AIDS Research Network of Integrated Clinical Systems cohort.

At the study period’s outset, 895 members of the study cohort had COPD. Another 451 were diagnosed with the condition during a median follow-up period of 3.44 years.

The study divided MI into two types: type 1, which was atherothrombotic coronary plaque rupture, and type 2, in which heart vessels contract instead of rupturing as a result of plaque buildup.

A total of 704 study members had heart attacks, 55 percent of which were type 1 and 45 percent of which were type 2. Of the 314 cases of type 2 heart attack, 201 (64 percent) occurred without sepsis and 113 (36 percent) occurred with sepsis.

After adjusting the data to account for differences between the cohort members in smoking and smoking duration, the study authors found thatCOPD was associated with a 2.08-fold increased risk of heart attack. This included a 1.73-fold increased of type 1 heart attack and 2.65-fold increased risk of type 2 heart attack.